The Tale of 2 OC Moms – Your Birth Location Matters!

April 28, 2010 in Birth, Birth Care Provider, Birth Location, Cesarean, Choose Wisely, Pregnancy

In Honor of Cesarean Awareness Month: a continuation of a Tale of Two OC Hospitals.

I had 2 first time moms in one of my Hypnobabies Classes.  Their births were similar in many ways – but had different outcomes.  In a large part due to the choice of their care providers and birth locations.

Mom 1 – Addison was birthing at hospital A, my favorite hospital (lowest cesarean rate, high VBAC rate, low episiotomy rate, no inductions before 40 week rule) with a care provider who has low intervention rates.  This mom was tiny and I was glad she was with this care provider.  Many others would have tried to scare her into a cesarean.

Mom 2 – Cara was birthing at hospital B, (higher cesarean rate, low VBAC rate, elective cesareans “encouraged” by many OBs)  She had a care provider I didn’t know.  But Cara was nervous about the care provider and asked my opinion a few times about changing.  I encouraged her to interview other care providers and gave her some options of those who are supportive of NCB.  But in the end she chose to stay with him.

If you were to guess right now, which one ended up with a cesarean, you would probably be right.  I asked these moms if they were willing for me to share their birth experiences so that other moms can learn how choosing your care provider and your birth location can have a big effect on if you end up with a cesarean or not.

Here are their experiences.  Tomorrow I will compare the two and look at what may have made the biggest differences.

Mom 1 – Addison

Early in her pregnancy she asked about their induction policies and about her cesarean rate.

The OB told her that they “only induce when it is medically necessary.”  She also said, “We only do cesareans when mom or baby are at risk.  C-sections are harder for baby and mom to recover from.  This makes it harder for me, because I am worried about mom and baby!” 

This helped Addison feel confident that her care provider was the right one for her.

39.5 weeks: Addison’s birthing time starts on it’s own.

Saturday night 8 PM her pressure waves (pw) were 5 min apart she went to the hospital.   She got sent home because she was 1cm.

Sunday morning at 9AM, her pw were 3 min apart lasting up to 90 seconds, she went to the hospital again, but was sent home again because she was still 1cm.

3:30 Sunday afternoon she went back to the hospital – She was 3cm!  Yay! She gets checked in and settled in her room.

The nurse did say, “If you want an epidural let us know.”

It was not mentioned again until Addison brought it up.

5 PM Sunday Addison gets an epidural so she could get some much needed rest.  (She was still 3cm)

Midnight (7 hours later), she is still 3cm.  Her care provider brings up trying pitocin.  Addison asks to wait another hour to see what happens and says, if there is still no progress, then I am willing to try it.  The care provider was fine with that.

An hour later, still no progress.  So they start the pitocin at 1ml.  The baby heart rate drops so they stop the pitocin.  This little bit was enough to get things started and she starts to progress.

In all this time a cesarean was never mentioned.

5 AM Addison started to push.

Her baby girl was born vaginally at 6:10 Monday morning.

Mom 2 – Cara

EDD from known date of conception is Dec. 1st.  When change to new OB midway through pregnancy he changed due date to Nov 27th based on 18 week ultrasound.  Mom still considers Dec 1st as EDD

Monday, Nov 30th Cara has an appointment.

Her OB does a vaginal exam and finds she is 0 cm 0 effaced.  OB says we need to do cesarean. This baby is not coming out on own.

She says “I’m not even due yet.”

OB’s response is  “I know you think your EDD is Dec 1st, but in the chart it is written down as 11/27.”  Her OB did mention induction, but because her Bishops score was so low it was unlikely to work and she would end up with a cesarean anyway.

Cara had been concerned about the baby’s activity level, so she schedules a cesarean for Thursday and her OB sends her to hospital for monitoring.   The baby is doing great, so Cara calls to cancel the cesarean.

That evening she loses her mucus plug.  While out to dinner with her DH her pressure waves (pw) start and they get more intense as the night progresses.

2AM Tuesday morning they head to the hospital, because the pw are 5 min apart.

She gets to the hospital and she is 2.5 cm dilated.  They admit her to the hospital.  Cara’s nurse is excited and says she has a good chance for a vaginal delivery.

Once she is checked into her room, her pw space out and don’t have a normal pattern.

6AM pitocin started to help get pw regulated.

Nurse comes in soon after the pitocin gets started and announces, “The best anesthesiologist is about to go off shift.  Do you want an epidural?”

Cara was managing her pw ok, but she was nervous that with the pitocin they were going to get harder to handle and who wouldn’t want the “best anesthesiologist”?  Cara says yes to the epidural.

7 AM epidural is placed and she is 3.5cm dilated.

With the epidural Cara found that she couldn’t really rest.  She felt shaky, her legs felt tingly and time seemed to pass so slowly.  She felt disconnected from her body and wasn’t sure it was doing anything.

(At some point maybe around 9AM, I called.  Cara had called the day before when her OB said she needed a cesarean.  I had left a message the day before reassuring her that her body knew how to birth a baby, but didn’t hear back, so I called again.  I was thrilled to hear her birthing time had started on its own.  I was a little nervous, because of her OBs comments the day before.  I thought, “If she hasn’t had this baby by 5, he is going to want to do a cesarean.”)

1PM she is 100% effaced and baby has dropped more into her pelvis.  But she hasn’t dilated any more.  The pitocin was upped to the max, and they had to turn it down a bit because she was having too many pressure waves.

The nurse told her “If you haven’t progressed anymore in an hour we will do a cesarean.”

2PM she is checked again, “no progress” had been made.  Cara had mentally prepared herself for this reality and because she isn’t really comfortable, even with the epidural and she is ready to meet her baby, she is ok with moving forward with the cesarean.

2:30PM her baby boy is born via cesarean! Cara said the best part is that the anesthesiologist really encouraged her to watch while they took the baby out.  She wasn’t sure about that, she was scared to see herself cut open.  But he reassured she would see the baby, not herself.  So she did watch and thought it was awesome.  That experience of seeing her baby come out helped it to be a positive birth experience.  She felt connected to him and the birth experience. 

She tells moms all the time now, to take that opportunity if they need a cesarean.

(Looking back Cara says she wishes she had waited longer to go to the hospital and also that she had waited to get an epidural.)

Can you see how hospital policies and staff attitudes can effect the outcome of a moms birth? What are your thoughts?  I will share my insights tomorrow.

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